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An S, Yu H, Islam MDM, Zhang X, Zhan Y, Olivieri JJ, Ambati J, Yao J, Gelfand BD. Effects of donor-specific microvascular anatomy on hemodynamic perfusion in human choriocapillaris. Sci Rep 2023; 13:22666. [PMID: 38114564 PMCID: PMC10730623 DOI: 10.1038/s41598-023-48631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
Evidence from histopathology and clinical imaging suggest that choroidal anatomy and hemodynamic perfusion are among the earliest changes in retinal diseases such as age-related macular degeneration (AMD). However, how inner choroidal anatomy affects hemodynamic perfusion is not well understood. Therefore, we sought to understand the influences of choroidal microvascular architecture on the spatial distribution of hemodynamic parameters in choriocapillaris from human donor eyes using image-based computational hemodynamic (ICH) simulations. We subjected image-based inner choroid reconstructions from eight human donor eyes to ICH simulation using a kinetic-based volumetric lattice Boltzmann method to compute hemodynamic distributions of velocity, pressure, and endothelial shear stress. Here, we demonstrate that anatomic parameters, including arteriolar and venular arrangements and intercapillary pillar density and distribution exert profound influences on inner choroidal hemodynamic characteristics. Reductions in capillary, arteriolar, and venular density not only reduce the overall blood velocity within choriocapillaris, but also substantially increase its spatial heterogeneity. These first-ever findings improve understanding of how choroidal anatomy affects hemodynamics and may contribute to pathogenesis of retinal diseases such as AMD.
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Affiliation(s)
- Senyou An
- State Key Laboratory of Intelligent Construction and Healthy Operation and Maintenance of Deep Underground Engineering, Shenzhen University, Shenzhen, 518060, China
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Huidan Yu
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA.
- Department of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - M D Mahfuzul Islam
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Xiaoyu Zhang
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Yuting Zhan
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
- Dyson School of Design Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Joseph J Olivieri
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Pathology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
| | - Jayakrishna Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Pathology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
| | - Jun Yao
- Research Center of Multiphase Flow in Porous Media, China University of Petroleum (East China), Qingdao, 266580, China
| | - Bradley D Gelfand
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
- Department of Ophthalmology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
- Department of Biomedical Engineering, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
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Grimes KR, Aloney A, Skondra D, Chhablani J. Effects of systemic drugs on the development and progression of age-related macular degeneration. Surv Ophthalmol 2023; 68:332-346. [PMID: 36731638 DOI: 10.1016/j.survophthal.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Age-related macular degeneration (AMD) is the leading cause of severe loss of central vision among people over 50. The pathophysiology of the disease is multifactorial and can be attributed to genetics, aging, inflammation, environmental factors, and lifestyle factors including smoking, diet, obesity, and alcohol consumption. While there is no treatment for dry AMD, the current standard treatment for wet AMD is an intraocular injection of anti-vascular endothelial growth factor-an effective, yet expensive, therapy that requires ongoing treatment. As the aging population continues to grow, and AMD diagnoses continue to rise, new treatments should be explored to reduce vision complications and decrease treatment burdens. Many systemic conditions have progressive pathological changes that may affect AMD, particularly those affecting systemic vasculature like diabetes and cardiovascular status. Consequently, systemic drugs used to treat coexistent systemic diseases may influence some of the pathogenic mechanisms of AMD and lead its progression or delay. In this review we explore the current literature to summarize the findings of the reported effects of antihypertensive, immunosuppressants, cholesterol lowering agents, nonsteroidal anti-inflammatory drugs, dopamine precursors, hypoglycemic agents, and anticoagulants on AMD.
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Affiliation(s)
- Kara R Grimes
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Abhilasha Aloney
- Eye Care Institute, PBMA'S H.V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, IL, USA
| | - Jay Chhablani
- Department of Ophthalmology, The University of Pittsburgh, Pittsburgh, PA, USA.
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3
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Lejoyeux R, Benillouche J, Ong J, Errera MH, Rossi EA, Singh SR, Dansingani KK, da Silva S, Sinha D, Sahel JA, Freund KB, Sadda SR, Lutty GA, Chhablani J. Choriocapillaris: Fundamentals and advancements. Prog Retin Eye Res 2021; 87:100997. [PMID: 34293477 DOI: 10.1016/j.preteyeres.2021.100997] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 12/19/2022]
Abstract
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
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Affiliation(s)
| | | | - Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Marie-Hélène Errera
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Sumit R Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Susana da Silva
- Department of Ophthalmology and Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Debasish Sinha
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Cell Biology and Center for Biologic Imaging, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - José-Alain Sahel
- Rothschild Foundation, 75019, Paris, France; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, Paris, France
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, USA; Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, New York University of Medicine, New York, NY, USA; Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, 90033, USA; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Anomalous Angiogenesis in Retina. Biomedicines 2021; 9:biomedicines9020224. [PMID: 33671578 PMCID: PMC7927046 DOI: 10.3390/biomedicines9020224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 12/14/2022] Open
Abstract
Age-related macular degeneration (AMD) may cause severe loss of vision or blindness, particularly in elderly people. Exudative AMD is characterized by the angiogenesis of blood vessels growing from underneath the macula, crossing the blood–retina barrier (which comprises Bruch’s membrane (BM) and the retinal pigmentation epithelium (RPE)), leaking blood and fluid into the retina and knocking off photoreceptors. Here, we simulate a computational model of angiogenesis from the choroid blood vessels via a cellular Potts model, as well as BM, RPE cells, drusen deposits and photoreceptors. Our results indicate that improving AMD may require fixing the impaired lateral adhesion between RPE cells and with BM, as well as diminishing Vessel Endothelial Growth Factor (VEGF) and Jagged proteins that affect the Notch signaling pathway. Our numerical simulations suggest that anti-VEGF and anti-Jagged therapies could temporarily halt exudative AMD while addressing impaired cellular adhesion, which could be more effective over a longer time-span.
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5
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Davies AE, Williams RL, Lugano G, Pop SR, Kearns VR. In vitro and computational modelling of drug delivery across the outer blood-retinal barrier. Interface Focus 2020; 10:20190132. [PMID: 32194934 PMCID: PMC7061949 DOI: 10.1098/rsfs.2019.0132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 12/22/2022] Open
Abstract
The ability to produce rapid, cost-effective and human-relevant data has the potential to accelerate the development of new drug delivery systems. Intraocular drug delivery is an area undergoing rapid expansion, due to the increase in sight-threatening diseases linked to increasing age and lifestyle factors. The outer blood-retinal barrier (OBRB) is important in this area of drug delivery, as it separates the eye from the systemic blood flow. This study reports the development of complementary in vitro and in silico models to study drug transport from silicone oil across the OBRB. Monolayer cultures of a human retinal pigmented epithelium cell line, ARPE-19, were added to chambers and exposed to a controlled flow to simulate drug clearance across the OBRB. Movement of dextran molecules and release of ibuprofen from silicone oil in this model were measured. Corresponding simulations were developed using COMSOL Multiphysics computational fluid dynamics software and validated using independent in vitro datasets. Computational simulations were able to predict dextran movement and ibuprofen release, with all of the features of the experimental release profiles being observed in the simulated data. Simulated values for peak concentrations of permeated dextran and ibuprofen released from silicone oil were within 18% of the in vitro results. This model could be used as a predictive tool for drug transport across this important tissue.
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Affiliation(s)
- Alys E. Davies
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Rachel L. Williams
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Gaia Lugano
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Serban R. Pop
- Department of Computer Science, University of Chester, Chester, UK
| | - Victoria R. Kearns
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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Rispoli M, Savastano MC, Lumbroso B. Quantitative Vascular Density Changes in Choriocapillaris Around CNV After Anti-VEGF Treatment: Dark Halo. Ophthalmic Surg Lasers Imaging Retina 2018; 49:918-924. [DOI: 10.3928/23258160-20181203-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
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Coleman DJ, Lee W, Chang S, Silverman RH, Lloyd HO, Daly S, Tsang SH. Treatment of Macular Degeneration with Sildenafil: Results of a Two-Year Trial. Ophthalmologica 2018; 240:45-54. [PMID: 29694963 DOI: 10.1159/000486105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/05/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate PDE5/6 inhibition with sildenafil to reduce choroidal ischemia and treat age-related macular degeneration. METHODS Sildenafil was prescribed to treat participants with macular degenerations or macular dystrophies measured by spectral-domain optical coherence tomography, color fundus photography, enhanced depth imaging, and best-corrected visual acuity. RESULTS No change in calcified drusen was noted. Vitelliform-type soft drusen were not substantially changed. A participant with Best vitelliform macular dystrophy had a significant improvement in vision as well as in photoreceptor and ellipsoid layers. CONCLUSIONS Our research supports sildenafil as a safe treatment for age-related and vitelliform macular degenerations. Thickened Bruch's membrane reduces the beneficial effect of perfusion increase, but all eyes appear to benefit from PDE6. Notably, maintenance or improvement in the photoreceptor layer may be the most significant result of sildenafil and is consistent with PDE6 inhibition. Thus, sil-denafil treatment of macular degeneration offers significant potential for vision retention and recovery.
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Affiliation(s)
- D Jackson Coleman
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Stanley Chang
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Ronald H Silverman
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Harriet O Lloyd
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Suzanne Daly
- Department of Ophthalmology, Columbia University, New York, New York, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, USA.,Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, New York, USA.,Department of Pathology and Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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8
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Theodossiadis P, Grigoropoulos V, Emfietzoglou I, Vergados J, Chalkiadakis J, Theodossiadis G. Intravitreal Bevacizumab for the Treatment of Feeder Vessel of Subfoveal Choroidal Neovascularization. Eur J Ophthalmol 2018; 17:853-6. [DOI: 10.1177/112067210701700528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - I. Emfietzoglou
- 2nd Department of Ophthalmology, Henry Dunant Hospital, Athens - Greece
| | - J. Vergados
- 2nd Department of Ophthalmology, University of Athens
| | - J. Chalkiadakis
- 2nd Department of Ophthalmology, Henry Dunant Hospital, Athens - Greece
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9
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Changes in Retinal and Choroidal Vascular Blood Flow after Oral Sildenafil: An Optical Coherence Tomography Angiography Study. J Ophthalmol 2017; 2017:7174540. [PMID: 29129998 PMCID: PMC5654255 DOI: 10.1155/2017/7174540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/16/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe changes in the retina and choroidal flow by optical coherence tomography angiography (OCT-A) after a single dose of oral sildenafil. Method A case-control study. Patients in the study group received 50 mg of oral sildenafil. Patients in the control group received a sham pill. Retinal and choroidal images were obtained at baseline (before pill ingestion) and 1 hour after ingestion. Central macular and choroidal thickness, choroidal and outer retina flow, and the retinal and choroidal vascular density were compared using a Mann-Whitney U test. Results Twenty eyes were enrolled into the study group and 10 eyes in the control group. There was a significant difference in central choroidal thickness and outer retina blood flow between groups after 1 hour of sildenafil ingestion (p < 0.01). There were no differences in central macular thickness, choroidal flow, and retinal vascular density among groups. Conclusions A single dose of oral sildenafil increases choroidal thickness, probably due to sildenafil-induced vasodilation.
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10
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Functional end-arterial circulation of the choroid assessed by using fat embolism and electric circuit simulation. Sci Rep 2017; 7:2490. [PMID: 28559567 PMCID: PMC5449384 DOI: 10.1038/s41598-017-02695-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/19/2017] [Indexed: 11/08/2022] Open
Abstract
The discrepancy in the choroidal circulation between anatomy and function has remained unsolved for several decades. Postmortem cast studies revealed extensive anastomotic channels, but angiographic studies indicated end-arterial circulation. We carried out experimental fat embolism in cats and electric circuit simulation. Perfusion defects were observed in two categories. In the scatter perfusion defects suggesting an embolism at the terminal arterioles, fluorescein dye filled the non-perfused lobule slowly from the adjacent perfused lobule. In the segmental perfusion defects suggesting occlusion of the posterior ciliary arteries, the hypofluorescent segment became perfused by spontaneous resolution of the embolism without subsequent smaller infarction. The angiographic findings could be simulated with an electric circuit. Although electric currents flowed to the disconnected lobule, the level was very low compared with that of the connected ones. The choroid appeared to be composed of multiple sectors with no anastomosis to other sectors, but to have its own anastomotic arterioles in each sector. Blood flows through the continuous choriocapillaris bed in an end-arterial nature functionally to follow a pressure gradient due to the drainage through the collector venule.
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11
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Gelfand BD, Ambati J. A Revised Hemodynamic Theory of Age-Related Macular Degeneration. Trends Mol Med 2016; 22:656-670. [PMID: 27423265 DOI: 10.1016/j.molmed.2016.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration (AMD) afflicts one out of every 40 individuals worldwide, causing irreversible central blindness in millions. The transformation of various tissue layers within the macula in the retina has led to competing conceptual models of the molecular pathways, cell types, and tissues responsible for the onset and progression of AMD. A model that has persisted for over 6 decades is the hemodynamic, or vascular theory of AMD progression, which states that vascular dysfunction of the choroid underlies AMD pathogenesis. Here, we re-evaluate this hypothesis in light of recent advances on molecular, anatomic, and hemodynamic changes underlying choroidal dysfunction in AMD. We propose an updated, detailed model of hemodynamic dysfunction as a mechanism of AMD development and progression.
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Affiliation(s)
- Bradley D Gelfand
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA; Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA; Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, KY, USA
| | - Jayakrishna Ambati
- Department of Ophthalmology and Visual Sciences, University of Kentucky, Lexington, KY, USA; Department of Physiology, University of Kentucky, Lexington, KY, USA.
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12
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Mathematical and computational models of the retina in health, development and disease. Prog Retin Eye Res 2016; 53:48-69. [PMID: 27063291 DOI: 10.1016/j.preteyeres.2016.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 12/12/2022]
Abstract
The retina confers upon us the gift of vision, enabling us to perceive the world in a manner unparalleled by any other tissue. Experimental and clinical studies have provided great insight into the physiology and biochemistry of the retina; however, there are questions which cannot be answered using these methods alone. Mathematical and computational techniques can provide complementary insight into this inherently complex and nonlinear system. They allow us to characterise and predict the behaviour of the retina, as well as to test hypotheses which are experimentally intractable. In this review, we survey some of the key theoretical models of the retina in the healthy, developmental and diseased states. The main insights derived from each of these modelling studies are highlighted, as are model predictions which have yet to be tested, and data which need to be gathered to inform future modelling work. Possible directions for future research are also discussed. Whilst the present modelling studies have achieved great success in unravelling the workings of the retina, they have yet to achieve their full potential. For this to happen, greater involvement with the modelling community is required, and stronger collaborations forged between experimentalists, clinicians and theoreticians. It is hoped that, in addition to bringing the fruits of current modelling studies to the attention of the ophthalmological community, this review will encourage many such future collaborations.
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13
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Lu L, Xu S, He F, Liu Y, Zhang Y, Wang J, Wang Z, Fan X. Assessment of Choroidal Microstructure and Subfoveal Thickness Change in Eyes With Different Stages of Age-Related Macular Degeneration. Medicine (Baltimore) 2016; 95:e2967. [PMID: 26962799 PMCID: PMC4998880 DOI: 10.1097/md.0000000000002967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Age-related macular degeneration (AMD) is a major cause of irreversible blindness. Choroidal structural changes seem to be inevitable in AMD pathogenesis. Our study revealed associated choroidal microstructural changes in AMD eyes.The aim of the study was to compare choroidal microstructural changes in eyes with AMD of different stages.The study was a retrospective, cross-sectional case series.The participants comprised of 32 age-matched normal eyes as controls, and 26 fellow uninvolved eyes of intermediate/late AMD, 29 of early AMD, 28 of intermediate AMD, and 39 of late AMD.All subjects underwent comprehensive ophthalmologic examination. The choroid images, including subfoveal choroidal thickness, percentage of Sattler layer area, and en face images of the choroid, were obtained using spectral-domain optical coherence tomography.The main outcome measures were subfoveal choroidal thickness changes, percentage of Sattler layer area changes, and en face images of the choroid in AMD eyes.One hundred fifty-four eyes of 96 individuals with mean age of 67.1±9.2 years were included. The mean subfoveal choroidal thickness was 295.4 ± 56.8 μm in age-matched normal eyes, 306.7 ± 68.4 μm in fellow uninvolved eyes with AMD, 293.8 ± 80.4 μm in early AMD, 215.6 ± 80.4 μm in intermediate AMD, and 200.4 ± 66.6 μm in late AMD (F = 14.2, all P < 0.001). Choroidal thickness was greater in early AMD eyes than in intermediate/late AMD eyes (P < 0.001). Mean percentage of Sattler layer area in each group showed a similar tendency. Microstructure of the choroid showed reduced vascular density of Sattler layer areas in late AMD eyes compared with normal eyes.Decreasing subfoveal choroidal thickness and percentage of Sattler layer area were demonstrated in the progression of AMD. The choroidal change was related to atrophy of the microstructural changes of underlying capillaries and medium-sized vessels.
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Affiliation(s)
- Linna Lu
- From the Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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14
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Choi W, Moult EM, Waheed NK, Adhi M, Lee B, Lu CD, de Carlo TE, Jayaraman V, Rosenfeld PJ, Duker JS, Fujimoto JG. Ultrahigh-Speed, Swept-Source Optical Coherence Tomography Angiography in Nonexudative Age-Related Macular Degeneration with Geographic Atrophy. Ophthalmology 2015; 122:2532-44. [PMID: 26481819 PMCID: PMC4658257 DOI: 10.1016/j.ophtha.2015.08.029] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/13/2015] [Accepted: 08/24/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To investigate ultrahigh-speed, swept-source optical coherence tomography (SSOCT) angiography for visualizing vascular changes in eyes with nonexudative age-related macular degeneration (AMD) with geographic atrophy (GA). DESIGN Observational, prospective, cross-sectional study. PARTICIPANTS A total of 63 eyes from 32 normal subjects and 12 eyes from 7 patients with nonexudative AMD with GA. METHODS A 1050-nm, 400-kHz A-scan rate SSOCT system was used to perform volumetric optical coherence tomography angiography (OCTA) of the retinal and choriocapillaris (CC) vasculatures in normal subjects and patients with nonexudative AMD with GA. Optical coherence tomography angiography using variable interscan time analysis (VISTA) was performed to assess CC alteration and differentiate varying degrees of CC flow impairment. MAIN OUTCOME MEASURES Qualitative comparison of retinal and CC vasculatures in normal subjects versus those in patients with a clinical diagnosis of nonexudative AMD with GA. RESULTS In all 12 eyes with GA, OCTA showed pronounced CC flow impairment within the region of GA. In 10 of the 12 eyes with GA, OCTA with VISTA showed milder CC flow impairment extending beyond the margin of GA. Of the 5 eyes exhibiting foveal-sparing GA, OCTA showed CC flow within the region of foveal sparing in 4 of the eyes. CONCLUSIONS The ability of ultrahigh-speed, swept-source OCTA to noninvasively visualize alterations in the retinal and CC vasculatures makes it a promising tool for assessing nonexudative AMD with GA. Optical coherence tomography angiography using VISTA can distinguish varying degrees of CC alteration and flow impairment and may be useful for elucidating disease pathogenesis, progression, and response to therapy.
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Affiliation(s)
- WooJhon Choi
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Nadia K Waheed
- New England Eye Center, Tufts University Medical Center, Boston, Massachusetts
| | - Mehreen Adhi
- New England Eye Center, Tufts University Medical Center, Boston, Massachusetts
| | - ByungKun Lee
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Chen D Lu
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Talisa E de Carlo
- New England Eye Center, Tufts University Medical Center, Boston, Massachusetts
| | | | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jay S Duker
- New England Eye Center, Tufts University Medical Center, Boston, Massachusetts
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Piri N, Ahmadieh H, Taei R, Soheilian M, Karkhaneh R, Lashay A, Golbafian F, Yaseri M, Riazi-Esfahani M. Photodynamic Therapy and Intravitreal Bevacizumab with Versus without Triamcinolone for Neovascular Age-related Macular Degeneration; a Randomized Clinical Trial. J Ophthalmic Vis Res 2015; 9:469-77. [PMID: 25709773 PMCID: PMC4329708 DOI: 10.4103/2008-322x.150826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/30/2014] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the outcomes of photodynamic therapy (PDT) combined with intravitreal bevacizumab (IVB) with versus without intravitreal triamcinolone (IVT) in neovascular age-related macular degeneration (AMD). METHODS Eighty-four eyes with active CNV secondary to AMD with no prior treatment were enrolled and followed for 1-year. Eligible eyes were randomly assigned to either PDT/IVB or PDT/IVB/IVT. The main outcome measure was change in best-corrected visual acuity (BCVA). RESULTS Mean patient age was 71 ± 9 years. BCVA changes from baseline were statistically significant in both study arms at all follow-up intervals, however no significant difference was observed between the two groups regarding BCVA changes at week 12 (95% CI:-0.11-0.12 LogMAR) and other time points (all P > 0.6). Mixed model analysis revealed a significant effect from age (P < 0.001), pigment epithelial detachment (P = 0.009) and baseline BCVA (P < 0.001) on visual improvement. Significant central macular thickness (CMT) reduction occurred at all-time points as compared to baseline in both groups which was comparable between the study arms. There was no significant difference between the study arms in terms of retreatment rate (P = 0.1) and survival to the first repeat IVB injection (P = 0.065). CONCLUSION Additional low-dose IVT to a PDT/IVB regimen for neovascular AMD provided no beneficial effects in terms BCVA or CMT, yet demonstrated a trend toward extending the injection-free period.
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Affiliation(s)
- Niloofar Piri
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, Louisville, KY, USA
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Taei
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Lashay
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faegheh Golbafian
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Moult E, Choi W, Waheed NK, Adhi M, Lee B, Lu CD, Jayaraman V, Potsaid B, Rosenfeld PJ, Duker JS, Fujimoto JG. Ultrahigh-speed swept-source OCT angiography in exudative AMD. Ophthalmic Surg Lasers Imaging Retina 2014; 45:496-505. [PMID: 25423628 PMCID: PMC4712918 DOI: 10.3928/23258160-20141118-03] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/04/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the potential of ultrahigh-speed swept-source optical coherence tomography angiography (OCTA) to visualize retinal and choroidal vascular changes in patients with exudative age-related macular degeneration (AMD). PATIENTS AND METHODS Observational, prospective cross-sectional study. An ultrahigh-speed swept-source prototype was used to perform OCTA of the retinal and choriocapillaris microvasculature in 63 eyes of 32 healthy controls and 19 eyes of 15 patients with exudative AMD. MAIN OUTCOME MEASURE qualitative comparison of the retinal and choriocapillaris microvasculature in the two groups. RESULTS Choroidal neovascularization (CNV) was clearly visualized in 16 of the 19 eyes with exudative AMD, located above regions of severe choriocapillaris alteration. In 14 of these eyes, the CNV lesions were surrounded by regions of choriocapillaris alteration. CONCLUSION OCTA may offer noninvasive monitoring of the retinal and choriocapillaris microvasculature in patients with CNV, which may assist in diagnosis and monitoring.
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Sakalar YB, Keklikci U, Unlu K, Alakus MF, Kara IH. Effects of photodynamic therapy with verteporfin for the treatment of chronic central serous chorioretinopathy: An uncontrolled, open-label, observational study. Curr Ther Res Clin Exp 2014; 71:173-85. [PMID: 24683263 DOI: 10.1016/j.curtheres.2010.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Central serous chorioretinopathy is an idiopathic disorder that leads to serous neurosensory retinal detachment. The disorder is usually self-limited and resolves spontaneously; however, sometimes neurosensory retinal detachment persists. This form of the disorder is called chronic central serous chorioretinopathy (CCSC). OBJECTIVE The aim of this study was to assess the effects of photodynamic therapy (PDT) on visual acuity with full-dose verteporfin for CCSC. METHODS The eyes of patients with CCSC were included in the study. Ophthalmic examination including best-corrected visual acuity (BCVA), fundus examination, fluorescein angiography, and optical coherence tomography was performed before treatment and at 1, 3, 6, 9, and 12 months. PDT with full-dose verteporfin (6 μ/m(2) of body surface area) was applied only to areas of active leakage. BCVA was converted to a log of the minimum angle of resolution (logMAR) equivalent for statistical analysis. Central foveal thickness and BCVA between baseline and follow-up were compared. RESULTS Seventeen eyes of 16 patients (13 males, 3 females; mean [SD] age, 39.75 [7.51] years; mean duration of follow-up, 13.06 [1.82] months) were used in the study. The mean (SEM) logMAR BCVA was 0.26 (0.07) at baseline and 0.04 (0.02) at 12 months. Mean logMAR BCVA values at baseline (0.259) and after treatment (0.112, 0.053, 0.047, 0.041, and 0.041 at 1, 3, 6, 9, and 12 months, respectively) differed significantly (P = 0.006, P = 0.005, P = 0.005, P = 0.005, and P = 0.005). There was a significant difference in the mean central foveal thickness at the final visit (169 μm) compared with the baseline value (383 μm; P < 0.001). BCVA decreased in one eye (20/20 vs 20/25) and persisted during follow-up; in the other 16 eyes, BCVA either increased (n = 10) or remained stable (n = 6). CONCLUSIONS In this small, open-label study, patients with CCSC treated with a single course of PDT with full-dose verteporfin had significant improvement from baseline in BCVA and resolution of subretinal fluid accumulation and active leakage. Treatment was generally well tolerated, but one patient had worsening in BCVA.
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Affiliation(s)
| | - Ugur Keklikci
- Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Kaan Unlu
- Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Fuat Alakus
- Department of Ophthalmology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ismail Hamdi Kara
- Department of Family Medicine, Duzce University Faculty of Medicine, Duzce, Turkey
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Coleman DJ, Silverman RH, Rondeau MJ, Lloyd HO, Khanifar AA, Chan RVP. Age-related macular degeneration: choroidal ischaemia? Br J Ophthalmol 2013; 97:1020-3. [PMID: 23740965 PMCID: PMC3717761 DOI: 10.1136/bjophthalmol-2013-303143] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim Our aim is to use ultrasound to non-invasively detect differences in choroidal microarchitecture possibly related to ischaemia among normal eyes and those with wet and dry age-related macular degeneration (AMD). Design Prospective case series of subjects with dry AMD, wet AMD and age-matched controls. Methods Digitised 20 MHz B-scan radiofrequency ultrasound data of the region of the macula were segmented to extract the signal from the retina and choroid. This signal was processed by a wavelet transform, and statistical modelling was applied to the wavelet coefficients to examine differences among dry, wet and non-AMD eyes. Receiver operating characteristic (ROC) analysis was used to evaluate a multivariate classifier. Results In the 69 eyes of 52 patients, 18 did not have AMD, 23 had dry AMD and 28 had wet AMD. Multivariate models showed statistically significant differences between groups. Multiclass ROC analysis of the best model showed an excellent volume-under-curve of 0.892±0.17. The classifier is consistent with ischaemia in dry AMD. Conclusions Wavelet augmented ultrasound is sensitive to the organisational elements of choroidal microarchitecture relating to scatter and fluid tissue boundaries such as seen in ischaemia and inflammation, allowing statistically significant differentiation of dry, wet and non-AMD eyes. This study further supports the association of ischaemia with dry AMD and provides a rationale for treating dry AMD with pharmacological agents to increase choroidal perfusion. ClinicalTrials.gov registration NCT00277784.
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Affiliation(s)
- D Jackson Coleman
- Department of Ophthalmology, Columbia University Medical Center, New York, New York 10032, USA.
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A randomized pilot study of low-fluence photodynamic therapy versus intravitreal ranibizumab for chronic central serous chorioretinopathy. Am J Ophthalmol 2011; 152:784-92.e2. [PMID: 21742303 DOI: 10.1016/j.ajo.2011.04.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE To report 6-month outcomes of a prospective, randomized study comparing the efficacy and safety between low-fluence photodynamic therapy (PDT) and intravitreal injections of ranibizumab in the treatment of chronic central serous chorioretinopathy. DESIGN Prospective, randomized, single-center pilot study. METHODS Sixteen eyes with chronic central serous chorioretinopathy were randomized to receive either low-fluence PDT or intravitreal injections of ranibizumab: 8 eyes in the low-fluence PDT group and 8 in the ranibizumab group. Rescue treatment was considered if subretinal fluid was sustained after completion of primary treatment: low-fluence PDT for the ranibizumab group and ranibizumab injection for the low-fluence PDT group. Main outcome measures were excess foveal thickness, resolution of subretinal fluid, choroidal perfusion on indocyanine green angiography, and best-corrected visual acuity. RESULTS At 3 months, the mean excess foveal thickness was reduced from 74.1 ± 56.0 μm to -35.4 ± 44.5 μm in the low-fluence PDT group (P = .017) and from 26.3 ± 50.6 μm to -23.1 ± 56.5 μm in the ranibizumab group (P = .058). After a single session of PDT, 6 eyes (75%) in the low-fluence PDT group achieved complete resolution of subretinal fluid and reduction of choroidal hyperpermeability, whereas 2 (25%) eyes in the ranibizumab group achieved this after consecutive ranibizumab injections. Four eyes (50%) in the ranibizumab group underwent additional low-fluence PDT and accomplished complete resolution. At 3 months, significant improvement of best-corrected visual acuity was not demonstrated in the low-fluence PDT group (P = .075), whereas it was observed in the ranibizumab group (P = .012). However, the tendency toward improvement of best-corrected visual acuity was not maintained. CONCLUSIONS In terms of anatomic outcomes, the effect of ranibizumab injections was not promising compared with that of low-fluence PDT.
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Caccavale A, Romanazzi F, Imparato M, Negri A, Morano A, Ferentini F. Central serous chorioretinopathy: a pathogenetic model. Clin Ophthalmol 2011; 5:239-43. [PMID: 21386917 PMCID: PMC3046994 DOI: 10.2147/opth.s17182] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Indexed: 11/23/2022] Open
Abstract
Despite numerous studies describing predominantly its demography and clinical course, many aspects of central serous chorioretinopathy (CSCR) remain unclear. Perhaps the major impediment to finding an effective therapy is the difficulty of performing studies with large enough cohorts, which has meant that clinicians have focused more on therapy than on a deeper understanding of the pathogenesis of the disease. Hypotheses on the pathogenesis of CSCR have ranged from a basic alteration in the choroid to an involvement of the retinal pigment epithelium (RPE). Starting from evidence that affected subjects often present a personality prone to stress with altered pituitary–hypothalamic axis response (HPA) and that they have higher levels of serum and urinary cortisol and catecholamines than healthy subjects, we hypothesize a cascade of events that may lead to CSCR through hypercoagulability and augmented platelet aggregation. In particular we investigated the role of tissue plasminogen activator, increasing plasminogen activator inhibitor 1 (PAI-1), and plasmin-α2- plasmin inhibitor complexes. We reviewed the different therapeutic approaches, including adrenergic antagonists, carbonic anhydrase inhibitors, mifepristone, ketoconazole, laser photocoagulation, intravitreal injection of bevacizumab, and photodynamic therapy with verteporfin (PDT) and our model of pathogenesis seems to be in agreement with the clinical effects obtained from these treatments. In accord with our thesis, we began to treat a group of patients affected by CSCR with low-dose aspirin (75–100 mg), because of its effectiveness in other vascular diseases and its low ocular and general toxicity with prolonged use. The formulation of a causative model of CSCR enables us to understand how the therapeutic approach cannot be based on a generalized therapy but should be individualized for each patient, and that sometimes a combined strategy of treatment is required. Moreover a complete knowledge of the disease will help to identify patients prone to the most persistent forms of CSCR, and thus help to find a treatment.
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Affiliation(s)
- Antonio Caccavale
- Department of Ophthalmology, Neuropthalmology and Ocular Immunology Service
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21
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Effect of photodynamic therapy alone or combined with posterior subtenon triamcinolone acetonide or intravitreal bevacizumab on choroidal hypofluorescence by indocyanine green angiography. Retina 2010; 30:495-502. [PMID: 19996828 DOI: 10.1097/iae.0b013e3181bcedbe] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Choroidal hypofluorescence has been reported beneath the photodynamic therapy (PDT) site in clinical studies. We evaluated the choroidal hypofluorescence after combined PDT with posterior subtenon injection of triamcinolone acetonide or PDT with an intravitreal injection of bevacizumab for age-related macular degeneration. METHODS Two hundred and forty-two eyes with a subfoveal choroidal neovascularization caused by age-related macular degeneration were studied. Ninety-two eyes underwent PDT alone, 90 eyes underwent PDT with sub-Tenon injection of triamcinolone acetonide, and 60 eyes underwent PDT with intravitreal injection of bevacizumab. Verteporfin-induced choroidal hypoperfusion was determined by indocyanine green angiograms. The intensity of the diffuse fluorescence within the PDT site away from the choroidal neovascularization lesion and from the normal retina just peripheral to the optic disk was measured by densitometry (Topcon IMAGEnet computer system, Topcon, Tokyo, Japan) in the indocyanine green angiogram images obtained at 10 minutes 3 months after the PDT. The ratio of the average brightness of the retina within the PDT area to that of the retina peripheral to the optic disk (irradiated/nonirradiated retinal brightness ratio) was calculated for each angiogram. RESULTS The irradiated/nonirradiated retinal brightness ratio of the angiograms was 0.96 in the PDT-alone group, 0.85 in the sub-Tenon injection of triamcinolone acetonide-PDT group, and 0.89 in the intravitreal injection of bevacizumab-PDT group (Kruskal-Wallis H test, P < 0.05). CONCLUSION The degree of choroidal hypofluorescence in the indocyanine green angiogram images 3 months after PDT in the sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab group was higher than that of PDT-alone group. Sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab can prolong the duration of the choroidal hypofluorescence after PDT.
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Zhu L, Banerjee RK, Salloum M, Bachmann A, Flower RW. Temperature Distribution During ICG-Dye-Enhanced Laser Photocoagulation of Feeder Vessels in Treatment of AMD-Related Choroidal Neovascularization. J Biomech Eng 2008; 130:031010. [PMID: 18532859 DOI: 10.1115/1.2898832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laser photocoagulation of the feeder vessels of age-related macula degeneration-related choroidal neovascularization (CNV) membranes is a compelling treatment modality, one important reason being that the treatment site is removed from the fovea in cases of sub- or juxtafoveal CNV. To enhance the energy absorption in a target feeder vessel, an indocyanine green dye bolus is injected intravenously, and the 805nm wavelength diode laser beam is applied when the dye bolus transits the feeder vessel; this tends to reduce concomitant damage to adjacent tissue. A 3D theoretical simulation, using the Pennes bioheat equation, was performed to study the temperature distribution in the choroidal feeder vessel and its vicinity during laser photocoagulation. The results indicate that temperature elevation in the target feeder vessel increases by 20% in dye-enhanced photocoagulation, compared to just photocoagulation alone. The dye bolus not only increases the laser energy absorption in the feeder vessel but also shifts the epicenter of maximum temperature away from the sensitive sensory retina and retinal pigment epithelial layers and toward the feeder vessel. Two dominant factors in temperature elevation of the feeder vessel are location of the feeder vessel and blood flow velocity through it. Feeder vessel temperature elevation becomes smaller as distance between it and the choriocapillaris layer increases. The cooling effect of blood flow through the feeder vessel can reduce the temperature elevation by up to 21% of the maximum that could be produced. Calculations were also performed to examine the effect of the size of the laser spot. To achieve the same temperature elevation in the feeder vessel when the laser spot diameter is doubled, the laser power level has to be increased by only 60%. In addition, our results have suggested that more studies are needed to measure the constants in the Arrhenius integral for assessing thermal damage in various tissues.
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Affiliation(s)
- Liang Zhu
- Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250
| | - Rupak K. Banerjee
- Departments of Mechanical Engineering, and Departments of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221
| | - Maher Salloum
- Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250
| | - Albert Bachmann
- Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250
| | - Robert W. Flower
- Departments of Ophthalmology, New York University, New York, NY; Departments of Ophthalmology, University of Maryland at Baltimore, Baltimore, MD 21201
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COMBINED PHOTODYNAMIC THERAPY AND INTRAVITREAL TRIAMCINOLONE FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PUNCTATE INNER CHOROIDOPATHY OR OF IDIOPATHIC ORIGIN. Retina 2008; 28:71-80. [DOI: 10.1097/iae.0b013e31815e9339] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Iriyama A, Obata R, Inoue Y, Takahashi H, Tamaki Y, Yanagi Y. Effect of posterior juxtascleral triamcinolone acetonide on the efficacy and choriocapillaris hypoperfusion of photodynamic therapy. Graefes Arch Clin Exp Ophthalmol 2007; 246:339-44. [PMID: 17805556 DOI: 10.1007/s00417-007-0667-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 07/23/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the effect of posterior juxtascleral triamcinolone acetonide (TA) injection combined with photodynamic therapy with verteporfin (PDT) for treating exudative age-related macular degeneration (AMD), the best-corrected visual acuity (BCVA), the retreatment rates and the rate of choroidal hypoperfusion were investigated. METHODS A total of 67 eyes with subfoveal choroidal neovascularization (CNV) due to AMD were included. Forty-four eyes underwent PDT alone (PDT-alone group), and 23 eyes underwent PDT with the posterior juxtascleral injection of TA (PDT+TA group). Every 3 months after the PDT, the eyes were evaluated with regard to BCVA and requirement for retreatment by fluorescein angiography (FA) with the aid of optical coherence tomography (OCT). Choroiocapillaris hypoperfusion was assessed by indocyanine green angiography (ICGA) at 3 and 12 months. All patients completed a 1-year follow-up. RESULTS At the baseline, there was no difference in lesion type, size or visual acuity between the two groups. At 1 year, the change in BCVA was -0.0811 logarithm of the minimum angle of resolution (LogMAR) in the PDT-alone group, compared with -0.0432 logMAR in the PDT+TA group. There was no significant difference in the change in BCVA between the two groups (P = 0.6910). The PDT+TA group required a lower mean number of treatments (1.64 compared with 2.34 [P = 0.0223]) and showed a higher rate of choriocapillaris occlusion at 3 months, but no significant difference at 1 year (P = 0.9243) CONCLUSIONS Fewer retreatments were required in the TA+PDT group. There was no significant difference in the change in BCVA between the two groups. Adjacent TA may promote short-term choriocapillaris hypoperfusion.
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Affiliation(s)
- Aya Iriyama
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Meyer CH, Eter N, Mennel S, Kroll P. Stumpfe Bulbustraumata am hinteren Pol in der optischen Kohärenz-Tomographie und Fluoreszenz-Angiographie. SPEKTRUM DER AUGENHEILKUNDE 2007. [DOI: 10.1007/s00717-007-0183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ranta VP, Urtti A. Transscleral drug delivery to the posterior eye: prospects of pharmacokinetic modeling. Adv Drug Deliv Rev 2006; 58:1164-81. [PMID: 17069929 DOI: 10.1016/j.addr.2006.07.025] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 07/31/2006] [Indexed: 01/12/2023]
Abstract
Basic biological research has provided new approaches to treat severe diseases of the retina and choroid, such as age related macular degeneration. Although it is possible to deliver drugs from a subconjunctival drug depot to the retina and choroid, the barriers and kinetics of this route of drug administration are not well known. In this review we investigate the pharmacokinetic aspects of transscleral drug delivery into the posterior eye with emphasis on pharmacokinetic modeling. The existing simulation models related to the transscleral drug delivery are reviewed and future directions for the model development are discussed. In addition, a new simulation model for the transscleral drug delivery based on permeability data is introduced. This compartmental model contains several ocular tissues (sclera, choroid, retinal pigment epithelium and vitreous) and it takes into account the clearance of the drug via choroidal circulation. The model is used to simulate the vitreous delivery of macromolecules based on the available data on FITC-dextran 70 kDa.
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Affiliation(s)
- Veli-Pekka Ranta
- Department of Pharmaceutics, University of Kuopio, FIN-70211 Kuopio, Finland.
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Imai H, Honda S, Nakanishi Y, Yamamoto H, Tsukahara Y, Negi A. Different transitions of multifocal electroretinogram recordings between patients with age-related macular degeneration and polypoidal choroidal vasculopathy after photodynamic therapy. Br J Ophthalmol 2006; 90:1524-30. [PMID: 16825279 PMCID: PMC1857528 DOI: 10.1136/bjo.2006.092783] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To compare and evaluate the transitions in retinal function after photodynamic therapy (PDT) between age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) using multifocal electroretinograms (mfERGs). METHODS 10 eyes with choroidal neovascularisation (CNV) secondary to AMD and 11 eyes with CNV secondary to PCV were included in the study. mfERGs were recorded before PDT, and 1 week and 3 months after PDT. mfERG recordings were acquired by a Veris system (V.3.1.3) using a 103 hexagon stimulus. The first-order kernel was used to calculate amplitudes and latencies. Mean amplitudes and latencies from two central rings rated 0-4 degrees of visual angle were analysed and compared with each disease. RESULTS In AMD, the mean first negative peak (N1) amplitudes tended to decrease, and the mean first positive peak (N1P1) amplitudes reduced to significant levels (p = 0.047) 1 week after PDT. 3 months after PDT, there were no significant differences in the mean N1 and N1P1 amplitudes compared with pre-PDT values. In PCV, there were no significant changes in the mean N1 and N1P1 amplitudes 1 week after treatment. However, 3 months after PDT, mean amplitudes showed significant increases in N1 (p = 0.008) and N1P1 (p = 0.006) amplitudes compared with pre-PDT values. CONCLUSIONS mfERG recording transitions are different between patients with AMD and those with PCV. In patients with AMD, these results may show transient impairments in retinal function 1 week after PDT, but in those with PCV, the efficacy of PDT is superior to the impairment after PDT.
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Affiliation(s)
- H Imai
- Department of Organ Therapeutics, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Tsai DC, Charng MJ, Lee FL, Hsu WM, Chen SJ. Different Plasma Levels of Vascular Endothelial Growth Factor and Nitric Oxide between Patients with Choroidal and Retinal Neovascularization. Ophthalmologica 2006; 220:246-51. [PMID: 16785756 DOI: 10.1159/000093079] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 11/04/2005] [Indexed: 11/19/2022]
Abstract
Because the blood flow is much more intense in the choroid than in the retina, it is interesting to explore whether choroidal neovascularization (CNV) is more influenced by plasma angiogenic factors than retinal neovascularization. The aim of this study was to investigate plasma profiles of vascular endothelial growth factor (VEGF) and nitric oxide (NO) in patients with CNV due to age-related macular degeneration (AMD) and in those with retinal neovascularization due to proliferative diabetic retinopathy (PDR). Seventy-seven subjects with AMD, 22 with PDR, and 42 nondiabetic, non-AMD controls were enrolled in this comparative case series. AMD subjects were classified into three groups: dry type (dry AMD, n = 17), wet type with active CNV (CNV/AMD, n = 42), and disciform scar due to advanced wet AMD (scar/AMD, n = 18). Plasma VEGF and NO levels of each subject were measured with enzyme-linked immunosorbent assay and chemiluminescence, respectively. Plasma VEGF level in CNV/AMD (median 256.0 pg/ml, interquartile range 146.4-375.3 pg/ml) was significantly higher than in PDR (124.8 pg/ml, 75.7-215.3 pg/ml; p = 0.004) and controls (120.3 pg/ml, 82.8-168.2 pg/ml, p =0.001). CNV/AMD also had the highest VEGF level among the AMD subgroups. Plasma NO level was significantly elevated in PDR (137.4 microM, 63.7-240.1 microM) when compared with CNV/AMD (71.8 microM, 42.4-113.3 microM; p = 0.004) and controls (62.6 microM, 39.0-114.9 microM; p = 0.002). There was no significant difference in NO levels among the AMD subgroups. No significant correlation between VEGF and NO levels was noted. These findings indicate that both circulating VEGF and NO may play different roles in the pathogenesis of retinal neovascularization and CNV.
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Affiliation(s)
- Der-Chong Tsai
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
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Kozak I, Cheng L, Cochran DE, Freeman WR. Phase I clinical trial results of verteporfin enhanced feeder vessel therapy in subfoveal choroidal neovascularisation in age related macular degeneration. Br J Ophthalmol 2006; 90:1152-6. [PMID: 16774958 PMCID: PMC1857394 DOI: 10.1136/bjo.2006.095141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the safety and effectiveness of extrafoveal photodynamic therapy (PDT) occlusion of feeder vessels (FVs) in patients with subfoveal choroidal neovascularisation (CNV) as a result of age related macular degeneration. METHODS FVs were identified using dynamic fluorescein and indocyanine green angiography with scanning laser ophthalmoscope. The standard doses of verteporfin and laser wavelength were used. The light dose was escalated by increasing the duration of the light dose so the light regimen was 50 J/cm2 for patients 1 and 2; 100 J/cm2 for patients 3, 4, 5; 125 J/cm2 for patients 6 and 7; and 150 J/cm2 for patients 8 and 9. Patients were examined at weeks 1, 4, and 12. RESULTS The mean improvement on EDTRS chart 3 months after treatment was an increase of 2.1 lines (p = 0.07). Closure of the FV was achieved angiographically in three eyes at various light doses, in three eyes the FV was hypoperfused, and in three eyes the vessels were were neither closed nor hypoperfused. At the last follow up all FVs were reperfused. There was no evidence of retinal damage. CONCLUSION Verteporfin enhanced FV therapy does not cause subfoveal retinal damage and may have potential to improve central vision in subfoveal CNV caused by exudative macular degeneration. It is not recommended as a monotherapy for CNV.
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Affiliation(s)
- I Kozak
- Jacobs Retina Center, University of California San Diego, La Jolla, CA 92037, USA.
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30
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Zhu L, Zheng Y, von Kerczek CH, Topoleski LDT, Flower RW. Feasibility of extracting velocity distribution in choriocapillaris in human eyes from ICG dye angiograms. J Biomech Eng 2006; 128:203-9. [PMID: 16524331 DOI: 10.1115/1.2165692] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Indocyanine green (ICG) dye angiography has been used by ophthalmologists for routine examination of the choroidal vasculature in human eyes for more than 20 years. In this study, a new approach is developed to extract information from ICG dye angiograms about blood velocity distribution in the choriocapillaris and its feeding blood vessels. ICG dye fluorescence intensity rise and decay curves are constructed for each pixel location in each image of the choriocapillaris in an ICG angiogram. It is shown that at each instant of time the magnitude of the local instantaneous dye velocity in the choriocapillaris is proportional to both the slope of the ICG dye fluorescence intensity curve and the dye concentration. This approach leads to determination of the absolute value of blood velocity in the choriocapillaris, assuming an appropriate scaling, or conversion factor can be determined. It also enables comparison of velocities in different regions of the choriocapillaris, since the conversion factor is independent of the vessel location. The computer algorithm developed in this study can be used in clinical applications for diagnostic purposes and for assessment of the efficacy of laser therapy in human eyes.
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Affiliation(s)
- L Zhu
- Department of Mechanical Engineering, University of Maryland, Baltimore County, Baltimore, MD 21250, USA.
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31
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Chan WM, Lai TYY, Wong AL, Tong JP, Liu DTL, Lam DSC. Combined photodynamic therapy and intravitreal triamcinolone injection for the treatment of subfoveal choroidal neovascularisation in age related macular degeneration: a comparative study. Br J Ophthalmol 2006; 90:337-41. [PMID: 16488958 PMCID: PMC1856972 DOI: 10.1136/bjo.2005.081299] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the outcomes of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularisation (CNV) caused by age related macular degeneration (AMD). METHODS 48 eyes from 48 patients with subfoveal CNV caused by AMD were prospective recruited, with 24 eyes treated with combined PDT with IVTA and compared with a control group of 24 eyes which received PDT monotherapy. In the combined treatment group, IVTA was performed immediately after PDT as an outpatient procedure. The mean number of treatments, mean logMAR best corrected visual acuity (BCVA), mean line of visual acuity changes, and proportion of patients without moderate visual loss at 1 year were compared between the combined and monotherapy groups. RESULTS At 1 year the logMAR BCVA for the PDT with IVTA group changed from 0.88 to 0.95 (p = 0.32 compared with baseline), whereas the logMAR BCVA for the monotherapy group reduced from 0.74 to 1.09 (p<0.001 compared with baseline). A significantly higher proportion of patients who had PDT with IVTA did not develop moderate visual loss at 1 year compared with the monotherapy group (70.8% and 33.3% respectively, p = 0.009). Eyes which had combined treatment had significantly fewer lines lost compared with monotherapy alone (0.7 and 3.5 lines respectively, p = 0.015). Subgroup analysis showed that PDT with IVTA is effective in preventing visual loss in both predominately classic and occult CNV groups. The mean number of treatments for the combined and monotherapy groups was 1.5 and 1.96 respectively (p = 0.076). CONCLUSIONS Combined PDT with IVTA appeared more effective statistically at 12 months for stabilisation of vision (<3 logMAR lines change) compared with PDT monotherapy. Further randomised control trials might be justified to conclude the efficacy of PDT with IVTA.
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Affiliation(s)
- W-M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong.
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Oner A, Karakucuk S, Mirza E, Erkilic K. Electrooculography After Photodynamic Therapy. Doc Ophthalmol 2006; 111:83-6. [PMID: 16514489 DOI: 10.1007/s10633-005-4410-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2005] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the changes in electrooculography (EOG) after photodynamic therapy (PDT). METHODS Thirty-eight eyes of 38 patients (21 males, 17 females) with choroidal neovascularization secondary to age related macular degeneration were included in this study. Standart PDT with verteporfin was performed on each patient. Serial EOG recordings were performed before, 1 week, and 1 month after PDT. RESULTS Mean age of the patients was 69.8+/-9.7 years (range 56 and 90 years). Seven days after PDT the visual acuity improved in 17 eyes, remained unchanged in 16 eyes and deteriorated in 5 eyes. One month after PDT the visual acuity findings were the same as the first week. New hemorrhages were seen in three eyes in the first week after PDT and visual acuity was decreased in those patients. No other patient complained of ocular and systemic adverse events. There was a statistically significant reduction in the Arden ratio of the EOG 1 week after PDT and the reduction persisted in the first month recordings. CONCLUSIONS The reduction in Arden ratio of EOG findings may indicate that retina pigment epithelium function could be affected after PDT.
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Affiliation(s)
- Ayse Oner
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey.
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Oner A, Karakucuk S, Mirza E, Erkilic K. The Changes of Pattern Electroretinography at the Early Stage of Photodynamic Therapy. Doc Ophthalmol 2006; 111:107-12. [PMID: 16514492 DOI: 10.1007/s10633-005-4608-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the short-term changes in pattern electroretinography (PERG) after photodynamic therapy (PDT). METHODS Thirty eyes of 30 patients (17 males, 13 females) with choroidal neovascularization secondary to age related macular degeneration were included in this study. Standard PDT with verteporfin was performed on each patient. Serial PERG recordings were performed before, 1 week, and 1 month after PDT. RESULTS Mean age of the patients was 69.6+/-8.4 years (range 56 and 90 years). One month after PDT, the visual acuity improved in 16 eyes, remained unchanged in 12 eyes and deteriorated in two eyes. New hemorrhages were seen in two eyes in the first week after PDT and visual acuity was decreased in those patients. No other patient complained of ocular and systemic adverse events. There was a statistically significant reduction in the amplitudes of P50 and N95 waves at the first week recordings after PDT. At 1 month after PDT, no significant differences in the P50 and N95 amplitudes were observed compared with pre-PDT PERG recordings. There were no significant changes in the latencies of P50 and N95 at the first week and first month recordings when compared with pre-treatment PERG values. CONCLUSIONS Reduction in P50 and N95 amplitudes suggests that transient impairments in macular function occur at the first week after PDT.
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Affiliation(s)
- Ayse Oner
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey.
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Rougier MB, François L, Fourmaux E, Isber R, Colin J, Korobelnik JF. Complications and lack of benefit after transpupillary thermotherapy for occult choroidal neovascularization: 1-year results. Retina 2005; 25:784-8. [PMID: 16141869 DOI: 10.1097/00006982-200509000-00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marie B Rougier
- Service d'Ophtalmologie, Université de Bordeaux 2, Bordeaux, France
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36
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Olivier S, Harissi-Dagher M, Sébag M. Photodynamic therapy for chronic serous detachment of the retinal pigment epithelium in a young patient. Can J Ophthalmol 2005; 40:214-6. [PMID: 16049540 DOI: 10.1016/s0008-4182(05)80039-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sébastien Olivier
- Ophthalmology Department, University of Montreal, CHUM Hôpital Notre-Dame, Que
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37
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Weber U, Hecker H. [Transpupillary thermotherapy for occult choroidal neovascularizations]. Ophthalmologe 2005; 102:355-62. [PMID: 15744490 DOI: 10.1007/s00347-004-1117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This contribution describes the results of transpupillary thermotherapy (TTT) for age-related exudative macular degeneration (AMD) with regression. PATIENTS AND METHODS In exudative AMD with occult choroidal neovascularization (CNV), transpupillary thermotherapy (TTT) was performed using a diode laser (Iridex) in unselected patients. Before therapy and 1, 3, and 6 months after the initial treatment the patients were examined clinically. Additionally threshold testing in the 10 degrees field (Humphrey) and fluorescein angiographies were documented at all check-ups. RESULTS With respect to vision, differences in the slope of the regression lines between small, medium, and large CNV were significant (p<0.001). The slope of the regressions lines was significant except for small CNV. Regarding the 10 degrees field (Humphrey), there were no statistical differences in the slope of the regression lines (p=0.867). CONCLUSIONS Transpupillary thermotherapy with small CNV did not show a statistically significant decrease of VA. Thus, in clinical terms early treatment of occult CNV with TTT seems to be able to prevent a further loss of visual acuity.
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Affiliation(s)
- U Weber
- Augenklinik des Klinikums Braunschweig, Akademisches Lehrkrankenhaus der Medizinischen Hochschule, Hannover.
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Shahidi M, Blair NP, Mori M, Zelkha R. Feasibility of Noninvasive Imaging of Chorioretinal Oxygenation. Ophthalmic Surg Lasers Imaging Retina 2004. [DOI: 10.3928/1542-8877-20040901-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mennel S, Hausmann N, Meyer CH, Peter S. Photodynamic therapy and indocyanine green guided feeder vessel photocoagulation of choroidal neovascularization secondary to choroid rupture after blunt trauma. Graefes Arch Clin Exp Ophthalmol 2004; 243:68-71. [PMID: 15660279 DOI: 10.1007/s00417-004-0964-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 06/09/2004] [Accepted: 06/11/2004] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe photodynamic therapy (PDT) and additional indocyanine green (ICG) guided feeder vessel photocoagulation as a treatment of choroidal neovascularization (CNV) secondary to choroidal rupture in case of blunt head trauma. DESIGN Interventional case report. METHODS A 61-year-old woman developed subfoveal CNV originating from a choroid tear 8 years after blunt head trauma. Four sessions of PDT were applied and an additional two consecutive sessions of selective ICG-guided feeder vessel photocoagulation conducted. RESULTS Transient reduction of leakage and closure of feeder vessels could not prevent further growth of the CNV. CONCLUSIONS PDT reduced leakage temporarily and additional ICG-guided feeder vessel photocoagulation closed treated feeder vessel and CNV. New feeder vessel formation and growth of CNV in case of traumatic choroid rupture could not be treated effectively by these two laser treatment modalities to prevent severe deterioration of visual acuity.
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Affiliation(s)
- Stefan Mennel
- Department of Ophthalmology, Philipps-University Marburg, Robert-Koch-Str. 4, 35037 Marburg, Germany.
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40
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Geddes CD, Parfenov A, Roll D, Gryczynski I, Malicka J, Lakowicz JR. Roughened silver electrodes for use in metal-enhanced fluorescence. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2004; 60:1977-83. [PMID: 15248975 PMCID: PMC2737399 DOI: 10.1016/j.saa.2003.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Revised: 10/06/2003] [Accepted: 10/15/2003] [Indexed: 05/24/2023]
Abstract
Roughened silver electrodes are widely used for surface-enhanced Raman scattering (SERS). We tested roughened silver electrodes for metal-enhanced fluorescence. Constant current between two silver electrodes in pure water resulted in the growth of fractal-like structures on the cathode. This electrode was coated with a monolayer of human serum albumin (HSA) protein that had been labeled with a fluorescent dye, indocyanine green (ICG). The fluorescence intensity of ICG-HSA on the roughened electrode increased by approximately 50-fold relative to the unroughened electrode, which was essentially non-fluorescent and increased typically two-fold as compared to the silver anode. No fractal-like structures were observed on the anode. Lifetime measurements showed that at least part of the increased intensity was due to an increased radiative decay rate of ICG. In our opinion, the use of in situ generated roughened silver electrodes will find multifarious applications in analytical chemistry, such as in fluorescence based assays, in an analogous manner to the now widespread use of SERS. To the best of our knowledge this is the first report of roughened silver electrodes for metal-enhanced fluorescence.
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Affiliation(s)
- Chris D. Geddes
- Center for Fluorescence Spectroscopy, Medical Biotechnology Center, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201, USA
| | - Alexandr Parfenov
- University of Maryland School of Medicine, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard St, Baltimore, MD 21201, USA
| | - David Roll
- Department of Chemistry, Roberts Wesleyan College, 2301 Westside Drive, Rochester, NY 14624, USA
| | - Ignacy Gryczynski
- University of Maryland School of Medicine, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard St, Baltimore, MD 21201, USA
| | - Joanna Malicka
- University of Maryland School of Medicine, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard St, Baltimore, MD 21201, USA
| | - Joseph R. Lakowicz
- University of Maryland School of Medicine, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard St, Baltimore, MD 21201, USA
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Lai TYY, Chan WM, Lam DSC. Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy. Am J Ophthalmol 2004; 137:826-33. [PMID: 15126146 DOI: 10.1016/j.ajo.2003.11.079] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2003] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the early changes in retinal function after photodynamic therapy (PDT) by multifocal electroretinogram (mfERG). DESIGN Prospective interventional case series. METHODS Seventeen eyes from 17 patients scheduled for standard PDT with verteporfin were prospectively recruited. Patients' diagnoses included choroidal neovascularization (CNV) secondary to age-related macular degeneration, idiopathic CNV, myopic CNV, polypoidal choroidal vasculopathy, and central serous chorioretinopathy. Serial mfERG recordings were performed before PDT, and at 4 days, 2 weeks, and 1 month after PDT. The first-order kernel N1 and P1 mfERG response from the central 0 to 7 degrees and peripheral 7 to 25 degrees were grouped and analyzed. The mean response amplitudes and peak latencies of the mfERG recordings were compared longitudinally. RESULTS There were statistically significant reductions in the mean N1 response amplitude for the central group at 4 days (P =.007) and 2 weeks after PDT (P =.024), in the mean P1 response amplitude for both the central (P =.006) and peripheral (P =.013) groups at 4 days, and for the central group at 2 weeks after PDT (P =.017). There were also statistically significant increases in the mean P1 response latencies at 4 days (P =.004) and at 2 weeks (P =.018) after PDT for the central group and at 4 days after PDT (P =.026) for the peripheral group. At 1 month after PDT, no significant differences in the N1 and P1 mean response amplitudes and peak latencies were observed compared with pre-PDT mfERG. CONCLUSIONS Transient impairments in retinal function for as long as 2 weeks after PDT were noticed by reduction in response amplitudes and a delay in peak latencies of mfERG. These findings may explain the common adverse event of subjective visual disturbance early after PDT with normal findings in visual acuity and ophthalmoscopy.
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Affiliation(s)
- Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong, China
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Desmettre T, Quentel G, Benchaboune M, Cohen SY, Mordon S, Gaudric A. Thérapie photodynamique et DMLA : arguments pratiques sur la base de cas cliniques pour retraiter ou surveiller lors du suivi. J Fr Ophtalmol 2004; 27:291-8. [PMID: 15039633 DOI: 10.1016/s0181-5512(04)96133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical and angiographic progression after photodynamic therapy (PDT) is usually slow, sometimes fluctuating and therefore difficult to evaluate. After several sessions of PDT, angiographic follow-up remains the basis for therapeutic management involving either a new PDT session or an alternative treatment. It remains difficult, however, to evaluate the activity and progression potential of the remaining neovessels. Imaging (angiography, optical coherence tomography) and functional data both contribute to the therapeutic decision. Certain patients require several sessions for a progressive reduction of the exudation. For others, the persistence of metamorphopsias and accentuation of the scotoma despite the treatment may entail alternative treatment. Thus, a perifoveal photocoagulation can be proposed to limit the extension of the scotoma if after a reasonable number of sessions, central visual acuity is not recovered; direct photocoagulation of a persistent active neovascular contingent, distant from the fixation zone (foveal or exenterated) can be proposed if it remains on the border of a stabilized lesion; the treatment of a feeder vessel can be proposed if it becomes visible and is associated with active neovessels with a persistent central serous detachment of the neuroretina. Lastly, performance status and patient wishes are important elements in the overall therapeutic project, especially if the eye involved is the second eye, in view of quickly initiating low-vision rehabilitation.
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Affiliation(s)
- T Desmettre
- Centre d'Imagerie, Laser, et Réadaptation Basse Vision, Lambersart.
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Gelisken F, Lafaut BA, Inhoffen W, Voelker M, Grisanti S, Bartz-Schmidt KU. Clinicopathological findings of choroidal neovascularisation following verteporfin photodynamic therapy. Br J Ophthalmol 2004; 88:207-11. [PMID: 14736776 PMCID: PMC1771999 DOI: 10.1136/bjo.2003.018754] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To report the clinicopathologic findings of surgically excised choroidal neovascularisation (CNV) three days after verteporfin photodynamic therapy (PDT). METHODS In three patients (three eyes) with age related macular degeneration, the CNV was surgically removed three days after PDT. The CNV specimens were examined by light microscopy. RESULTS The patients had subfoveal classic CNV. Fluorescein angiography revealed non-perfusion of the CNV after PDT and before surgery in all eyes. The light microscopy of the CNV membranes showed swollen and damaged endothelium. Thrombus formation or vascular occlusion in the CNV vessels was not detected. CONCLUSION PDT did not cause a thrombosis of the vessels within the CNV three days after PDT. Severe endothelial damage of the CNV was observed and is likely a primary effect of PDT. Non-perfusion of the CNV at this stage is possibly secondary to occlusion at a deeper level, namely the underlying feeding choroid.
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Affiliation(s)
- F Gelisken
- Department of Ophthalmology I, University of Tuebingen, Schleichstrasse 12, 72076 Tuebingen, Germany.
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Cardillo Piccolino F, Eandi CM, Ventre L, Rigault de la Longrais RC, Grignolo FM. Photodynamic therapy for chronic central serous chorioretinopathy. Retina 2004; 23:752-63. [PMID: 14707823 DOI: 10.1097/00006982-200312000-00002] [Citation(s) in RCA: 270] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether photodynamic therapy (PDT) is effective for treatment of chronic central serous chorioretinopathy (CSC). METHODS Sixteen eyes with chronic CSC and macular detachment documented by optical coherence tomography (OCT) received PDT guided by indocyanine green (ICG) angiography according to the parameters outlined in the TAP Study. One or more laser spots were applied to the areas of choroidal vascular hyperpermeability that corresponded to retinal pigment epithelium decompensation. Patients were observed for 6 to 12 months. Two PDT sessions 1 month apart were performed on 2 eyes. Examinations included visual acuity measurement, fundus biomicroscopy, fluorescein and ICG angiography, and OCT. RESULTS Macular exudation resolved completely in 13 eyes (81%) and partially regressed in 3. Choriocapillaris hypoperfusion was shown by ICG angiography for several months at the site of PDT application. Visual acuity improved 1 to 4 lines in 11 eyes and was unchanged in 5 eyes. CONCLUSIONS ICG-guided PDT performed according to the parameters outlined by the TAP Study seems effective for treating chronic CSC. Further studies are needed to verify treatment safety and the time and rate of recurrences.
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Affiliation(s)
- Felice Cardillo Piccolino
- Institute of Ophthalmology, Department of Clinical Physiotherapy, University of Torino, Turin, Italy.
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Battaglia Parodi M. The origin of the hypofluorescent spot after photodynamic therapy. Am J Ophthalmol 2003; 136:584-5; author reply 585-6. [PMID: 12967839 DOI: 10.1016/s0002-9394(03)00488-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peyman GA, Genaidy M, Moshfeghi DM, Ghahramani F, Yoneya S, Men G, Kuo PC, Bezerra Y, Nishiyama-Ito Y. Transpupillary thermotherapy threshold parameters: funduscopic, angiographic, and histologic findings in pigmented and nonpigmented rabbits. Retina 2003; 23:371-7. [PMID: 12824839 DOI: 10.1097/00006982-200306000-00014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of pigmentation on threshold fluence levels, needed to produce visible and angiographic lesions, of transpupillary thermotherapy (TTT) in rabbits. METHODS Six pigmented and nine nonpigmented rabbits underwent TTT with an 810-nm diode laser coupled to a slit-lamp biomicroscope using a spot size of 2 or 3 mm. The power ranged from 80 to 200 mW with 1 to 3 minutes of laser exposure for pigmented rabbits and 750 to 1800 mW with 1 minute of exposure for albino rabbits. These parameters were also evaluated after compression of the globe using the contact lens to induce blanching of the optic nerve head. After the experiment, the eyes were enucleated under deep anesthesia, and the animals were killed immediately. RESULTS In pigmented rabbits, the threshold fluence with the 2-mm spot size was 229 J/cm2 without compression and 153 J/cm2 with compression. With the 3-mm spot size, the threshold decreased from 200 to 150 mW as the duration of exposure lengthened (2 or 3 minutes), increasing the fluence from 170 to 382 J/cm2. In nonpigmented rabbits, the threshold fluence with the 2-mm spot size was 2,865 J/cm2 without compression and 2,674 J/cm2 with compression. With the 3-mm spot size, the threshold fluence of 1,528 J/cm2 was not affected by compression. Histopathologic studies showed transretinal damage at the lowest levels necessary to achieve angiographic evidence of a treatment lesion or a barely visible funduscopic lesion at the time of treatment. CONCLUSIONS Nonpigmented rabbits required more than a 12-fold increase in total TTT fluence compared with pigmented rabbits with the 2-mm spot size and a ninefold increase with the 3-mm spot size. Inner and outer retinal damage was seen histopathologically at these levels.
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Affiliation(s)
- Gholam A Peyman
- Department of Ophthalmology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112-2699, USA.
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Peyman GA, Genaidy M, Yoneya S, Men G, Ghahramani F, Kuo PC, Bezerra Y, Nishiyama-Ito Y, Moshfeghi AA. Transpupillary thermotherapy threshold parameters: effect of indocyanine green pretreatment. Retina 2003; 23:378-86. [PMID: 12824840 DOI: 10.1097/00006982-200306000-00015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effect of combined treatment with systemic indocyanine green (ICG) on threshold fluence levels of transpupillary thermotherapy (TTT) in rabbits. METHODS Four pigmented rabbits and 13 nonpigmented rabbits were studied. TTT was performed on normal rabbit choriocapillaris using an 810-nm diode laser via slit-lamp biomicroscope delivery through a Goldmann macular lens. Laser spot size, power, and duration of laser exposure were varied to achieve a range of TTT fluences for threshold testing in both albino and pigmented rabbit fundi. Intravenous ICG pretreatment at doses of 0.41 to 10 mg/kg was initiated at varying times before TTT treatment. After the experiment, the eyes were enucleated under deep anesthesia, the animals were killed, and the eyes were prepared for light microscopy. RESULTS When intravenous ICG pretreatment was employed, there was a dose-dependent decrease in the TTT fluence threshold as compared with known threshold values. At threshold fluences, histopathologic sections revealed damage to all layers of the retina in addition to choriocapillaris damage. CONCLUSION Intravenous ICG pretreatment can be used to lower the TTT threshold fluence and irradiance required to create angiographically visible lesions in the normal rabbit choriocapillaris. Damage was seen in all layers of the retina and choriocapillaris at threshold levels when TTT was used alone or in combination with ICG pretreatment.
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Affiliation(s)
- Gholam A Peyman
- Department of Ophthalmology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112-2699, USA.
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Geddes CD, Cao H, Gryczynski I, Gryczynski Z, Fang J, Lakowicz JR. Metal-Enhanced Fluorescence (MEF) Due to Silver Colloids on a Planar Surface: Potential Applications of Indocyanine Green to in Vivo Imaging. J Phys Chem A 2003; 107:3443-3449. [PMID: 31896931 PMCID: PMC6939471 DOI: 10.1021/jp022040q] [Citation(s) in RCA: 227] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined the effects of metallic silver colloids on the fluorescence spectral properties of indocyanine green (ICG), which is a dye widely used for in vivo medical testing. Silver colloids from a suspension bind spontaneously to amine-coated surfaces. These colloid-coated surfaces were found to cause a 30-fold increase in the intensity of ICG, which was held close to the metal surface by adsorbed albumin. The increased intensities of ICG were also associated with decreased lifetimes and increased photostability, which are indicative of modifying the fluorophores radiative decay rate. These results suggest the use of metal colloid-enhanced ICG for applications to retinal angiography and vascular imaging and as a contrast agent for optical tomography.
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Affiliation(s)
- Chris D Geddes
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Haishi Cao
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Ignacy Gryczynski
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Zygmunt Gryczynski
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Jiyu Fang
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
| | - Joseph R Lakowicz
- University Maryland Baltimore, Center for Fluorescence Spectroscopy, Department of Biochemistry and Molecular Biology, 725 West Lombard Street, Baltimore, Maryland 21201
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Moshfeghi DM, Kaiser PK, Grossniklaus HE, Sternberg P, Sears JE, Johnson MW, Ratliff N, Branco A, Blumenkranz MS, Lewis H. Clinicopathologic study after submacular removal of choroidal neovascular membranes treated with verteporfin ocular photodynamic therapy. Am J Ophthalmol 2003; 135:343-50. [PMID: 12614752 DOI: 10.1016/s0002-9394(02)01936-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To report the clinicopathologic findings after submacular removal of choroidal neovascular membranes (CNV) treated with verteporfin ocular photodynamic therapy. DESIGN Interventional case series. METHODS Retrospective review of eight eyes of eight patients who underwent submacular surgery for CNV after having previously received verteporfin ocular photodynamic therapy for presumed ocular histoplasmosis (one patient), age-related macular degeneration ([AMD] three patients) pathologic myopia (two patients), punctate inner choroiditis (one patient), and idiopathic CNV (one patient). All cases had undergone ocular photodynamic therapy with verteporfin using standard protocols. Six of eight patients suffered a submacular hemorrhage after ocular photodynamic therapy, and two of eight patients refused further ocular photodynamic therapy. All patients subsequently had submacular surgery with removal of the CNV. One membrane was routinely processed, sectioned, and stained with hematoxylin and eosin. Five membranes were stained with toluidine blue for light microscopic examination. Semithin (1.0 microm) sections were cut and stained with uranyl acetate-lead citrate for transmission electron microscopy. RESULTS Choroidal neovascular membranes were removed at 3 days (presumed ocular histoplasmosis), 29 days (punctate inner choroiditis), 63 days (AMD, pathologic myopia), 66 days (AMD), 107 days (pathologic myopia), 116 days (AMD), and 152 days (idiopathic) after verteporfin ocular photodynamic therapy. Histopathologic and ultrastructural examination showed areas of vascular occlusion at 3 days that were not seen at later time points. All specimens had patent CNV. There were signs of vascular damage with extravasated erythrocytes and fibrin, pigment clumping in cells, and inflammatory cells in all but the 3-day specimen. CONCLUSIONS This case series presents data only from patients who refused repeat treatment with ocular photodynamic therapy or who developed submacular hemorrhage after initial photodynamic therapy. Histopathologic evaluation of CNV 3 days after verteporfin ocular photodynamic therapy showed partial vascular occlusion that was not present in later specimens. These later specimens demonstrated evidence of vascular damage. Verteporfin ocular photodynamic therapy does not appear to lead to permanent and complete occlusion of the CNV. Thus, treatments that lead to permanent closure of CNV without damage to the retinal pigment epithelium and sensory retina are still needed.
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Affiliation(s)
- Darius M Moshfeghi
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Clinical observations supporting a theoretical model of choriocapillaris blood flow in treatment of choroidal neovascularization: Author reply. Am J Ophthalmol 2003. [DOI: 10.1016/s0002-9394(02)01864-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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